Distally Based Saphenous Neurocutaneous Perforator Flap: A Versatile Donor Site for Reconstruction of Soft Tissue Defects of the Medial Malleolar Region

Zhong, Wanrun; Lu, Shengdi; Chai, Yimin

doi:10.1053/j.jfas.2015.02.002

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…Free flaps can provide adequate soft tissue in lower 1/3 cruris reconstruction and are often considered as the first choice for the reconstruction of this area. However, free flap transfer is a complex surgical operation, and complications such as flap failure, deep vein thrombosis, and cardiac events have been reported up to 17% in some studies . Moreover, free flap losses have been reported to occur at higher rates in traumatic extremities .…”

Section: Discussionmentioning

confidence: 99%

“…However, free flap transfer is a complex surgical operation, and complications such as flap failure, deep vein thrombosis, and cardiac events have been reported up to 17% in some studies. 21,22 Moreover, free flap losses have been reported to occur at higher rates in traumatic extremities. 1 The duration of PTAPF surgery is much shorter than that of free flap surgeries and can be performed under regional anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications

Aksan

Ertekin

et al. 2019

International Wound Journal

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Ankle fractures are among the most common orthopaedic surgical procedures. Skin‐related complications of these surgeries are difficult to reconstruct due to the inadequacy of soft tissue in the region. Although free flaps are generally considered as the first choice in reconstruction of this area, free flaps may not be a suitable option especially in patients with advanced age and comorbidities. Perforator flaps offer a fast and safe alternative in lower extremity reconstruction. In the literature, there are a limited number of studies using perforator flaps in managing the postoperative complications of the lower extremity trauma surgeries. In our study, we report our experience with reconstruction of soft‐tissue defects of medial malleolar region using posterior tibial artery perforator flap for postoperative complications of ankle fracture‐related surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications

Aksan

Ertekin

et al. 2019

International Wound Journal

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“…Unlike in the proximally based, a temporary venous congestion is common in the distally based flaps due to the retrograde flow of the venous blood and one-way valvular system. This problem is more pronounced in the distally based saphenous flaps due to more intense blood flow 12 . Small concomitant bypass veins surrounding the small and great saphenous veins enable drainage of the flaps.…”

Section: Discussionmentioning

confidence: 99%

“…The dissection of the adipofascial pedicle continues into the subfascial plane up to the point of rotation which is usually 5-6 cm above the medial malleolus. The pivot point is determined by the location of the most distal anastomosis with perforator of the posterior tibial artery 12 .…”

Section: Distally Based Saphenous Flapmentioning

confidence: 99%

Neurocutaneous flaps for soft tissue reconstruction of the knee, lower leg, ankle and foot: Clinical experience with 32 patients

et al. 2019

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Background/Aim. Neurocutaneous flaps (NF) are the type of fasciocutaneous flaps whose clinical application has increasingly grown over the years. They have become an indispensable step in the reconstructive ladder for the small and medium soft tissue defects of the lower leg and foot. The aim of this study was to analyse the results of the treatment of patients with lower extremity soft tissue defects caused by trauma, infection, tumour removal or unstable scar formation, which were reconstructed with a variety of NF. Methods. This retrospective study includes 32 consecutive patients with soft tissue defects of the lower limb, treated in the Clinical Centre of Vojvodina from January 2004 to April 2017. All the operations were performed in regional anaesthesia with pneumatic tourniquet. Design of the flap and length of the pedicle were determined by the size and position of the recipient site after necessary debridement. The flap was harvested, rotated and positioned in the defect region. The patients and flap data were summarized upon their collection. Results. The average age of the patients, mostly males (81.2%), was 46.7 years. Distally based sural flaps were used in a majority of patients (56.2%), followed by the distally based saphenous (21.9%), lateral sural (12.5%) and proximally based sural flaps (9.4%). Defects were most often localized on the distal third of the lower leg and on the ankle (53.1%). The most common indication for surgery were trauma (46.9%) and chronic infection (31.2%). A satisfactory coverage of the defect was achieved in all 32 patients with no flap loss. A partial necrosis of the flap due to prolonged venous congestion was noted in 3 (9.4%) patients, which were healed by second intention or with delayed skin grafting. Five (15.6%) patients developed a localised infection. The infection signs withdrew spontaneously in 2 cases and after a surgical revision in 3 cases, where osteitis of the tibia had persisted. One of them required the Ilizarov orthopaedic procedure after bone resection. Conclusion. NF proved to be a paramount alternative to free-flap reconstruction of the lower limb. Intensive clinical application can be explained by the fact that it is a less technically demanding and time consuming surgical procedure with no major source vessel sacrifice. The reliability and safety of their utilisation are confirmed by our clinical data.

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“…The previous study reported satisfactory results of the sural and the saphenous neurocutaneous flap for soft tissue defects coverage in lower extremities. [5][6][7][8][9][10][11][12][13] Since then, the vascularity of the lateral, medial, and posterior cutaneous nerves of the forearm has been studied, and researchers have examined a variety of neurocutaneous flap applications in upper extremity with excellent results and less complications. [2][3][4]14 This study is interested in the neurocutaneous flap that depends on the lateral antebrachial cutaneous nerve (LACN), the most reliable blood supply from the main underlying vessels of the forearm.…”

mentioning

confidence: 99%

The Lateral Antebrachial Neurocutaneous Flap: A Cadaveric Study and Clinical Applications

Kanchanathepsak

Rojpitipongsakorn

Tawonsawatruk

et al. 2020

J Reconstr Microsurg

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Background The neurocutaneous flap is an axial pattern flap that receives a vascular supply from a vessel along its cutaneous nerve and has favorable outcomes when used for soft tissue reconstruction in the upper extremities. The neurocutaneous flap depends on the lateral antebrachial cutaneous nerve (LACN) and its retrograde-flow has been studied via cadaveric dissection. The aim of this study is to prove the vascularity of the lateral antebrachial neurocutaneous (LABN) flap. Methods The distally based LABN flap was created in 18 upper limbs (12 cadavers). The skin flap was dissected at the proximal half of the forearm and then diluted methylene blue was injected through the brachial artery. The pedicle of the flap on the distal half of the forearm was dissected along the LACN for the anatomical study of the perforating branches, paraneural vessels, and flap territory. Results The mean age of cadavers was 74.1 years (nine males). The mean distance of most distal and proximal perforating branches from the radial styloid process were 2.32 ± 0.59 and 11.17 ± 1.72 cm, respectively. The mean total number of perforating branches was 7.4, which abundantly appeared approximately 4 to 5 cm from the radial styloid process. The mean flap territory was 8.64 ± 0.82 cm in width and 10.50 ± 1.90 cm in length. The mean forearm circumference was 24.84 ± 1.52 cm, and mean forearm length was 24.74 ± 1.8 cm. Conclusion This study ensured that retrograde-flow via the neurocutaneous artery could be provided through the vascularity of the LABN flap, which suggests that the pivot point of the flap should not extend beyond 5 cm proximal to the radial styloid process. The LABN flap is a useful alternative method for performing soft tissue reconstruction in hand and wrist defects without sacrificing the major vessels.

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Distally Based Saphenous Neurocutaneous Perforator Flap: A Versatile Donor Site for Reconstruction of Soft Tissue Defects of the Medial Malleolar Region

Cited by 8 publications

References 20 publications

Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications

Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications

Neurocutaneous flaps for soft tissue reconstruction of the knee, lower leg, ankle and foot: Clinical experience with 32 patients

The Lateral Antebrachial Neurocutaneous Flap: A Cadaveric Study and Clinical Applications

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